Thoracic Trauma Flashcards
Tension pneumothorax
Often laceration to lung parenchyma with flap
Pressure develops in thorax
Most common cause is mechanical ventilation in patient with pleural injury
Symptoms overlap with cardiac tamponade, hyper-resonant percussion note is more likely in tension pnemothorax
Flail Chest
Chest wall disconnects from thoracic cage
Multiple rib fractures (at least two fractures per rib in at least two ribs)
Associated with pulmonary contusion
Abnormal chest motion
Avoid over hydration and fluid overload
Pneumothorax
Most common cause is lung laceration with air leakage
Most traumatic pneumothoraces should have a chest drain
Patients with traumatic pneumothorax should never be mechanically ventilated until a chest drain is inserted
Haemothorax
Most commonly due to laceration of lung, intercostal vessel or internal mammary artery
Haemothoraces large enough to appear on CXR are treated with large bore chest drain
Surgical exploration is warranted if >1500ml blood drained immediately
Cardiac Tamponade
Beck’s triad: elevated venous pressure, reduced arterial pressure, reduced heart sounds
Pulsus paradoxus
May occur with as little as 100ml blood
Pulmonary Contusion
Most common potentially lethal chest injury
Arterial blood gases and pulse oximetry important
Early intubation within an hour if significant hypoxia
Blunt Cardiac Injury
Usually occurs secondary to chest wall injury
ECG may show features of myocardial infarction
Sequelae: hypotension, arrhythmias, cardiac wall motion abnormalities
Aorta Disruption
Deceleration injuries
Contained haematoma
Widened mediastinum
Diaphragm Disruption
Most due to motor vehicle accidents and blunt trauma causing large radial tears (laceration injuries result in small tears)
More common on left side
Insert gastric tube, may pass into intrathoracic stomach
Mediastinal Traversing Wounds
Entrance wound in one hemithorax and exit wound/foreign body in opposite hemithorax
Mediastinal haematoma or pleural cap suggests great vessel injury
Mortality is 20%
